Medical AR Follow-up & Denial Specialist

 Position Summary:

We are currently seeking a Medical AR Follow-up & Denial Specialist to join our committed team of professionals.

The Medical AR Follow-up & Denial Specialist is primarily responsible for analyzing and resolving all insurance claim denials for Critical Care and Pulmonary Sleep Associate providers. The individual in this position will generate effective written appeals to carriers using well-researched logic in order to recoup reimbursement on incorrectly denied claims.  Appeal carrier denials through coding review, contract review, medical record review, and carrier interaction.  Utilize a multitude of resources to ensure correct appeal processes are followed and completed in a timely manner.  Demonstrate a high level of expertise in the management of denied claims and deploy an analytical approach to resolving denials while recognizing trends and patterns in order to proactively resolve recurring issues. Communicate identified denial patterns to management.  Prioritize and process denials while maintaining high quality of work.  Serve as an escalation point for unresolved denial issues.  Inform team members of payer policy changes.  Assist in educating employees when needed.  Collaborate on special projects as needed. Assist manager of additional tasks as needed.

Essential Responsibilities and Tasks:

• Reviews denied claims to ensure coding was appropriate and make corrections as needed.
• Ensures billing and coding are correct prior to sending appeals or reconsiderations to payers.
• Investigate claims with no payer response to ensure claim was received by payer
• Strong understanding of payer websites and appeal process by all payers including commercial and government payers including VA, Tricare, Medicare, Medicaid, and Medicare Advantage plans
• Reviews and finds trends or patterns of denials to prevent errors
• Assists and confers with coder and billing manager concerning any coding problems.
• Strong research and analytical skills. Must be a critical thinker.
• Stays current with compliance and changing regulatory guideline.
• Demonstrates knowledge of coding and medical terminology in order to effectively know if claim denied appropriately and if appeal is warranted.
• Supports and participates in process and quality improvement initiatives.
• Achieve goals set forth by supervisor regarding error-free work, transactions, processes and compliance requirements.
• Promote the CCPSA culture of team collaboration, while identifying and implementing opportunities to enhance the shared values of the group.
• Exhibit exceptional customer service skills; answering patient and insurance calls; prompt return and follow up to all interactions; prompt response to requests for information, both internally and externally.
• Proactive resolution of issues and timely response to questions and concerns.
• Clearly document issues and resolution.
• Deliver timely required reports to the management team; initiates and communicates the resolution of issues, such as payor denial trends due to coding and billing errors.
• Responsible for working follow up work queues.
• Responsible for identifying missing payments, overpayments, and analyzing credits on accounts.
• Ability to successfully track and follow up on information requests.
• Work with group to facilitate information and resolve charge questions.
• Other duties as assigned.

Skills, Education and/or Work Experience Requirements:

• Minimum of 3 years’ experience in a medical billing department with strong AR account follow-up, appeals, and coding knowledge is a must.
• Demonstrated knowledge of and experience in Healthcare medical billing, claims processing, follow-up and appeals a must.
• Extensive knowledge on use of email, search engine, Internet; ability to effectively use payer websites; knowledge and use of Microsoft Products: Outlook, Word & Excel.
• Strong reasoning, critical thinking, analytical and mathematical skills.
• Ability to work independently, flexibly shifting from big picture to detailed tasks, with high productivity, and regularly execute to deadlines.
• CPC certification is preference but not required.
• EPIC EHR with Resolute Professional Billing module working knowledge and experience a strong preference but not required.
• High School Diploma or GED required.

Physical Requirements:

• Ability to safely and successfully perform the essential job functions consistent with the ADA, FMLA and other federal, state and local standards, including meeting qualitative and/or quantitative productivity standards.
• Ability to drive between CCPSA Denver metro clinic and hospital locations intermittently for meetings.
• Ability to sit for extended time periods.
• Must be able to bend, lift and carry up to 20 lbs.

Compensation:

• Competitive pay.
• Benefits effective date-of-hire (no waiting period).
• Comprehensive medical benefits. Company covers 80-85% percent of individual or family premium.
• Dental and vision benefits offered at no cost to the employee. Company covers 100% of individual or family premium.
• Life and AD&D benefits.
• Optional additional life & disability insurance at group discounts.
• PTO and holiday pay.
• 401k benefits with company contribution after eligibility period.
• Position reports to CCPSA’s Coding and AR Supervisor.